I work on a busy MedSurg unit. Concerned about thorny issue of "allowing" patient going out to smoke who is a known drug addict (her own admission) with IV access. She is gone so frequently she misses her scheduled doses of vancomycin and invanz for a badly infected surgical incision, lab draws for vanc troughs, etc. Pt actually left and went home AMA and was gone over two hours, then wanted to come back because it was time for her next morphine shot.
Staff is split on how to handle this type of patient. Legal/ethical/liability concerns about her going off the floor to smoke, going home and returning with iv access still intact. Had UDS upon arriving back to hospital, was POS for marijuana. Need consistent plan of care that all staff will follow to reduce the manipulation, etc., that this patient does with staff.
The unit I work on admits alot of IV drug users. First we have the pt searched by security.It is amazing what is found!Secondly a Health care agreement (HCA) is given to the pt by the DR. and the pt must sign it. One statement in the HCA is that the pt will NOT leave the floor for any reason if they do they will be discharged.Imagine if the pt leaves the floor to smoke or whatever and they meet their heroin supplier, use, and then come backup to the floor and ask for their IV Dilaudid!We also reserve the right to restrict visitors if we suspect they are using. My facility also has a no smoking policy and pts may recieve an HCA for trying to sneak off the floor to smoke( the hospital is liable for that pt out there smoking!).The HCA is great it keeps everyone safe and draws clear boundries and consequences.
we do not have a behavior unit, but we still get this problem. Our policy is to have patient sign out AMA. MD is asked to write RX for patches and if patient refuses then they may leave or stay, but not go outside. This became an issue when a patient on morphine PCA went outside, called a friend who came by with a needle to aspirate tubing to PCA and both had a good time. All this with staff and others watching, mind you.
Sunnysidegirl
58 Posts
The unit I work on admits alot of IV drug users. First we have the pt searched by security.It is amazing what is found!Secondly a Health care agreement (HCA) is given to the pt by the DR. and the pt must sign it. One statement in the HCA is that the pt will NOT leave the floor for any reason if they do they will be discharged.Imagine if the pt leaves the floor to smoke or whatever and they meet their heroin supplier, use, and then come backup to the floor and ask for their IV Dilaudid!We also reserve the right to restrict visitors if we suspect they are using. My facility also has a no smoking policy and pts may recieve an HCA for trying to sneak off the floor to smoke( the hospital is liable for that pt out there smoking!).The HCA is great it keeps everyone safe and draws clear boundries and consequences.